Lerch R, Wölfle K D, Loeprecht H
Department of Vascular and Thoracic Surgery, Zentralklinikum Augsburg, Germany.
Ann Vasc Surg. 1996 Nov;10(6):582-8. doi: 10.1007/BF02000448.
The case of a 50-year-old woman with an extremely rare venous malformation of the portal venous system is reported. The patient presented with a true aneurysm of the superior mesenteric vein, which has thus far been reported in no more than eight cases worldwide. This malformation may be congenital or acquired. Secondary aneurysms are thought to be due to liver disease, portal hypertension, trauma, or inflammation. Aneurysms of the portomesenteric venous system may be asymptomatic or give rise to severe, often dramatic conditions such as crampy abdominal pain, jaundice, and upper gastrointestinal hemorrhage secondary to portal hypertension. The diagnosis is usually made by ultrasound (B-mode or color flow Doppler), CT scan, and MRI. Invasive procedures such as venous phase mesenteric arteriography or splenoportography may be helpful in confirming it. In our opinion aneurysms of the portal venous system, even if they are congenital and (still) asymptomatic, require early surgical control because the prognosis for patients with these aneurysms is unpredictable and potential complications (e.g., portal hypertension, fistula, contained perforation, or rupture) may be fatal. In the case presented the mesenteric venous aneurysm was resected and the confluent veins were reconstructed.
报告了一例50岁女性患有门静脉系统极为罕见的静脉畸形的病例。该患者表现为肠系膜上静脉真性动脉瘤，迄今为止，全球报道不超过8例。这种畸形可能是先天性的或后天获得性的。继发性动脉瘤被认为是由肝脏疾病、门静脉高压、创伤或炎症引起的。肠系膜门静脉系统动脉瘤可能无症状，也可能引发严重的、通常是剧烈的病症，如痉挛性腹痛、黄疸以及门静脉高压继发的上消化道出血。诊断通常通过超声（B超或彩色多普勒血流成像）、CT扫描和MRI进行。诸如静脉期肠系膜动脉造影或脾门静脉造影等侵入性检查可能有助于确诊。我们认为，门静脉系统动脉瘤即使是先天性且（目前）无症状，也需要早期手术控制，因为这些动脉瘤患者的预后不可预测，潜在并发症（如门静脉高压、瘘管、局限性穿孔或破裂）可能是致命的。在本病例中，肠系膜静脉动脉瘤被切除，汇合静脉得以重建。
